الفهرس 
ANATOMY OF UPPER AIRWAYOnly 14 pages are availabe for public view
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Abstract
S
urgical emphysema is simply defined as air or gas trapped in the subcutaneous layer. When applying external pressure during palpation, a discernible crackling or popping will be noted similar to squeezing bubble wrap. The amount of swelling or edema depends on the amount of air or gas trapped.
The most common cause of subcutaneous emphysema is trauma, spontaneous air dissection may result when pulmonary alveolar or gastrointestinal continuity is violated, when infection with gas producing organisms, such as a gas gangrene is present, when air is pumped to subcutaneous tissue through existing cutaneous ulcer, or when air is injected to subcutaneous tissue.
Pneumomediastinum is caused by the fact that the air is tends to follow the pathway of least resistance, which determined by lengthening and shortening of the bronchvascular rays and makes its way toward the hilum.
Surgical emphysema and other manifestation of barotrauma are commonly seen in the critical care setting but rarely in the operating room. The differential diagnosis includes disruption of cutaneous barriers, disruption of mucosal barriers, barotrauma and infection from an anatomical standpoint, mucous membrane disruption of the oropharynx, tracheobronchial tree and esophagus can lead to surgical emphysema.
Surgical emphysema is a common observation associated with neck and chest trauma. It generally originates in the chest and may dissect up to the neck. The dissection is following the fascial planes of the neck that connect to mediastinum and loose areolar tissue between the chest wall and the muscles of the shoulder girdle. The actual air in the tissue is of little consequence, but it is a very important sing of potentially serious injuries to larynx, esophagus and tracheobronchial tree.
Surgical emphysema indicates a more serious pulmonary insult than is apparent on the surface. One clue to the severity of the complaint is to examine the patient medical history and mechanism of injury. It may rarely compromise respiration through restriction of chest movement or compression of tracheal or laryngeal structures. The management of such respiratory compromise has been described as urgent intubation or tracheostomy.
Surgical emphysema often presents a therapeutic dilemma when it progresses beyond the stage of tactile fascination. Even when it is a sever subcutaneous emphysema rarely has a pathophysiologic consequence, but it extremely uncomfortable for the patient and the family. When subcutaneous emphysema is sever, physicians may feel compelled to treat it.
Many of surgical emphysema cases are self-limiting without serious sequel. Conservative management consisting of observation and oxygen therapy would be appropriate. Positive pressure ventilation should be avoided. Further investigation should be ordered based on the degree of clinical suspicion.
Surgical emphysema is often dramatic but rarely life-threatening. When it does become life-threatening, infraclavicular blow hole technique should facilitate management of the patient.
A simply constructed catheter that can be used for subcutaneous emphysema. It is made with equipment that is available on most medical wards and can be easily placed by the physician at the bed site. The goal is to relieve the discomfort
and to prevent complications associated with subcutaneous emphysema.